When concepts no longer capture reality: outlining the post-bareback era by rethinking categories and retooling language in social science and behavioral research

Published: July 21, 2010

When concepts no longer capture reality: outlining the post-bareback era by rethinking categories and retooling language in social science and behavioral research

S. Barraud1, G. Fadel2, O. Jablonski3

1Warning-Montréal, Montreal, Canada, 2Université du Québec a Montréal (UQAM), Montreal, Canada, 3Warning-Paris, Paris, France

Issues: Research regarding risk behavior, HIV transmission risk and the international debate on treatment as prevention (TasP) needs to employ new terminology to accurately describe MSMs’ various prevention strategies.
Description: Condom use and UAI measures do not accurately portray individual prevention strategies. UAI does not capture the 37.6% of HIV- and 43.3% of HIV+ MSM in San Francisco that report seroadaptive behavior (Snowden, 2009). Several researchers and activists also recognize that barebacking is a polysemic vernacular word designating various segmented situations structured by multiples definitions (Scarce 2010; Elford, 2007; Halkitis, 2005; Dowsett, 2004; Léobon, 2004; Kippax, 2003), scales of intentionality and auto-identification (Berg, 2009) and actualized knowledge about risk transmission (Le Talec, 2008). The use of barebacking is no longer functional from a public health prevention perspective (Carballo-Dieguez, 2009).
Using an approach focusing solely on UAI or barebacking does not take into account the multi-factorial complexity of MSM’s sexuality and choice of prevention strategy. We need to adopt a post-bareback vocabulary that goes beyond barebacking, at risk behavior and UAI to avoid problematic terms that are politically polemic, moralizing, and inaccurate. These terms are counter-productive since they can reinforce homophobia, stigma and criminalization (Barraud, 2009). Furthermore, these terms eclipse other types of risk such as Hepatitis C and other STIs. Consequently, Warning started using new terms like sex-without-latex, seroadaptation and serochoice. These concepts don’t have moral connotations. They are descriptive, and recognize overall health and the variability of pleasure, desire and sexualities of MSM.
Lessons learned: A semantic effort must be made to have a better understanding of the dynamics of risk reduction behavior and other prevention strategies. We must stop focusing on zero risk and reject judgmental interpretations, social labeling and behavioral control temptations.
Next steps: New research on seroadaptation will better guide prevention efforts by focusing on the various realities of MSMs.

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